When Medrol Isn't Available, You Still Have Options

If your pharmacy can't fill your Medrol (Methylprednisolone) prescription, don't panic. Several other corticosteroids can treat the same conditions effectively. The key is working with your doctor to find the right substitute at the right dose.

In this guide, we'll walk through the best alternatives to Medrol, how they compare, dosing equivalencies, and what to discuss with your healthcare provider.

Understanding Corticosteroid Equivalencies

Not all corticosteroids are created equal. They differ in potency, duration of action, and how much they affect mineral balance (salt and water retention). Here's the standard equivalency chart for anti-inflammatory effect:

• Methylprednisolone (Medrol): 4mg
• Prednisone: 5mg
• Prednisolone: 5mg
• Dexamethasone: 0.75mg
• Hydrocortisone: 20mg
• Betamethasone: 0.6mg

These doses are approximately equivalent in their anti-inflammatory effect. Your doctor will use these ratios to calculate the right dose of any substitute medication.

Alternative #1: Prednisone — The Most Common Substitute

Prednisone is the most widely prescribed oral corticosteroid in the United States and is almost always in stock at pharmacies. It's inexpensive (often under $10 for a course), available in multiple strengths (1mg, 2.5mg, 5mg, 10mg, 20mg, 50mg), and treats all the same conditions as Medrol.

How It Compares to Medrol

• Potency: 5mg Prednisone ≈ 4mg Methylprednisolone
• Duration: Similar intermediate duration of action (12–36 hours)
• Key difference: Prednisone is a prodrug — your liver converts it to Prednisolone (the active form). For most patients, this conversion happens efficiently and there's no meaningful clinical difference
• Mineralocorticoid effect: Slightly higher than Methylprednisolone, meaning marginally more water retention

When Prednisone Is a Good Fit

For the vast majority of patients, Prednisone is an excellent direct substitute for Medrol. If you were prescribed a Medrol Dosepak taper, your doctor can easily write an equivalent Prednisone taper.

Alternative #2: Prednisolone

Prednisolone is the active metabolite of Prednisone. It's available as tablets and an oral liquid (solution and syrup), making it particularly useful for children or patients who have difficulty swallowing tablets.

How It Compares to Medrol

• Potency: 5mg Prednisolone ≈ 4mg Methylprednisolone
• Key advantage: Doesn't require liver conversion, making it preferred for patients with liver disease
• Available as: Tablets (5mg, 10mg, 15mg, 20mg, 30mg) and oral solution

Alternative #3: Dexamethasone

Dexamethasone is a much more potent corticosteroid with a longer duration of action. It's commonly used for short-course treatment and became widely known during the COVID-19 pandemic.

How It Compares to Medrol

• Potency: 0.75mg Dexamethasone ≈ 4mg Methylprednisolone (about 5–6x more potent)
• Duration: Longer-acting (36–72 hours vs. 12–36 hours for Medrol)
• Mineralocorticoid effect: Very low — causes less water retention
• Key consideration: Because it's more potent and longer-acting, dosing adjustments are critical

When Dexamethasone Is a Good Fit

Dexamethasone works well for short-course anti-inflammatory treatment, croup in children, certain cancer-related indications, and situations where minimal water retention is important.

Alternative #4: Hydrocortisone

Hydrocortisone is the pharmaceutical name for cortisol — the body's natural stress hormone. It's the least potent of the alternatives but has an important role.

How It Compares to Medrol

• Potency: 20mg Hydrocortisone ≈ 4mg Methylprednisolone
• Duration: Short-acting (8–12 hours)
• Key advantage: Most physiologic replacement for adrenal insufficiency
• Mineralocorticoid effect: Highest of the group — more salt and water retention

When Hydrocortisone Is a Good Fit

Hydrocortisone is the preferred choice for adrenal insufficiency replacement therapy. It's less commonly used as a Medrol substitute for anti-inflammatory purposes because of its lower potency and higher mineralocorticoid effects.

What About the Medrol Dosepak Taper?

If you were specifically prescribed a Medrol Dosepak (the 6-day tapered course of Methylprednisolone 4mg tablets), your doctor can easily convert this to an equivalent taper using another corticosteroid. The most common conversion is to a Prednisone taper:

• Day 1: 30mg Prednisone (equivalent to 24mg Methylprednisolone)
• Day 2: 25mg Prednisone (equivalent to 20mg Methylprednisolone)
• Day 3: 20mg Prednisone (equivalent to 16mg Methylprednisolone)
• Day 4: 15mg Prednisone (equivalent to 12mg Methylprednisolone)
• Day 5: 10mg Prednisone (equivalent to 8mg Methylprednisolone)
• Day 6: 5mg Prednisone (equivalent to 4mg Methylprednisolone)

Important: Never attempt to convert doses on your own. Always have your doctor write a new prescription with specific dosing instructions.

Important Considerations When Switching Corticosteroids

Don't Switch Without Your Doctor

While corticosteroids are generally interchangeable with proper dose adjustments, switching should always be done under medical supervision. Your doctor will consider your specific condition, other medications, kidney and liver function, and any history of side effects.

Watch for Different Side Effect Profiles

Each corticosteroid has a slightly different side effect profile. For example, Dexamethasone may cause more insomnia due to its longer duration, while Hydrocortisone may cause more water retention. Your doctor can help you anticipate and manage these differences. Learn more about Medrol side effects and what to watch for.

Consider Drug Interactions

If you're taking other medications, check that the substitute corticosteroid doesn't have any new interactions. Most corticosteroids share similar interaction profiles, but it's worth confirming. See our guide on Medrol drug interactions for more information.

Still Looking for Medrol?

If you'd prefer to stick with Medrol, it may still be available at other pharmacies in your area. Use MedFinder to check real-time availability, or read our guide to finding Medrol in stock near you for more strategies.

The Bottom Line

Not being able to find Medrol is stressful, but it's not a dead end. Prednisone is the most straightforward substitute and is almost always available. Prednisolone, Dexamethasone, and Hydrocortisone are also effective options depending on your situation. Talk to your doctor, get the right dose conversion, and continue your treatment without interruption.